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Incidence of Autism on the rise post-pandemic according to experts!

by Vaishali Sharma
written by Vaishali Sharma

Hear ‘N’ Say Clinic – a specialized centre for people with Hearing, speech and language disorders; hosted a unique workshop, Let’s Talk, for parents of children with Autism Spectrum Disorder (ASD), kids suffering from ASD and Medical Professionals dealing with the special kids, from across the state.

Autism Is a disorder associated with sensory processing leading to difficulties in organising and responding to information received from the sensory organs. These kids are often misunderstood by the society and face immense challenges impacting their physical and mental wellbeing and growth.There are indications of rise in ASD cases in the last one year with most therapists seeing more cases than normal. Pandemic impacted ASD children the most, the change in their daily routine and that of their families, in addition to minimal social exposure led to greater stress amongst them. These kids require regular therapy sessions to improve their abilities, especially during the crucial ages of 2 to 6 years, when maximum brain development takes place in the infant. But pandemic put a break on these sessions, the children were deprived of the therapy and lost unrecoverable precious years.

 

 

 

The ‘Let’s Talk’ workshop was packed with interesting knowledge sharing sessions and activities to help cope with these special kids and mould them into near normal individuals. There were four activities for kids and two hands on training for parents to demonstrate behavioural issues and ways to handle them.Therapists pretended like children with Autism spectrum disorder and parents were asked to react on how they handle the situation. Parents were advised and guided on conducive practices to address the issues and were able to see live the encouraging response from the kids.

 

 

 

Let’s Talk was a much awaited opportunity for parents and professionals alike to share insights, practices, outcomes, mock sessions, all of which helped to unlearn and learn the best practices which made ASD kids feel comfortable and can enable them to develop their sensory organs. This session seemed essential, as there is a sea change in the post-pandemic scenario related to ASD kids and their behaviour, the brainstorming of all stakeholders helped to asses, tweak, develop protocols afresh and hopefully these make a difference to the ASD children, says Dr. Garima Vegivada, Clinical Director- Speech Language Pathology, Hear ‘N’ Say Clinic, Secunderabad.

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Neurology News

Narcotic Drugs and Psychotropic Substances Amendment Bill is expected to be introduced today

by Pragati Singh
written by Pragati Singh

On Monday, Union Finance Minister Nirmala Sitharaman will introduce the Narcotic Drugs and Psychotropic Substances (Amendment) Bill, 2021 in the Lok Sabha, which will decriminalise the possession of a limited quantity of drugs for personal use while regulating certain operations such as the manufacture, transportation, and consumption of narcotic drugs and psychotropic substances.

The Bill will replace the ordinance of the same name, promulgated on September 30 to amend the Narcotic Drugs and Psychotropic Substances Act, 1985 to correct a drafting error, according to PRS Legislative Research.

The move to decriminalise possession of a limited quantity of drugs for personal use is being done with the view to help the victims of drug abuse come out of addiction. The recommendations in this regard were made to the Prime Minister’s office on November 10 by various ministries including from the department of revenue, home ministry, Narcotics Control Bureau (NCB), social justice ministry and health ministry.

The National Institute of Pharmaceutical Education and Research (Amendment) Bill, 2021 and the High Court and Supreme Court Judges (Salaries and Conditions of Service) Amendment Bill, 2021 may also be tabled in the Lok Sabha on Monday.

The former, which will be introduced by Union health minister Dr Mansukh Mandaviya, provides for granting the status of national importance to the six institutes in Ahmedabad, Guwahati, Hajipur, Hyderabad, Kolkata and Raebareli.

Two sessions after the Assisted Reproductive Technology (Regulations) Bill, 2020 was passed in the Lok Sabha by a voice vote, the Union health minister will be introducing the Bill for passage in the Rajya Sabha on Monday. The Bill aims to regulate assisted reproductive technology (ART) services such as in-vitro fertilization (IVF) centres, sperm or egg banks etc that have mushroomed across the country.

Dr Mandaviya will also be introducing the Surrogacy (Regulation) Bill, 2020 in the Rajya Sabha. It was passed by Lok Sabha in August 2019 before it was referred to a Select Committee, which recommended that the ART Bill is brought first, so that all the highly technical and medical aspects could subsequently be addressed in the Surrogacy (Regulation) Bill, 2019.

The Surrogacy Bill provisions for a National Surrogacy Board that will be involved in policy making and also in supervision, and State Boards that will act as executive bodies.

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Neurology News

Obstructive Sleep apnea (OSA)

by Dr. Hitesh Verma
written by Dr. Hitesh Verma

BY: Dr Hitesh Verma, Additional Professor (ENT), AIIMS, New Delhi

Sleep apnea & hypopnea is a sleep disorder in which cessation/ reduction of respiratory effort at the nostril level for few seconds to a few minutes. It is subdivided in central, obstructive & mixed types. Obstructive sleep apnea (OSA) is the commonest subtype. Sedentary lifestyle, faulty eating habits & lack of physical activities are the predisposing factors for obesity. The collection of fat within & around the upper aerodigestive tract reduces the dimensions of airway lumen which increases the turbulence in the air current. Snoring is induced by turbulent airflow during sleep. The snoring loudness increases with severity of airway narrowing. The anatomical abnormalities (nasal, nasopharyngeal, oropharyngeal, hypopharyngeal & laryngeal) is generally responsible for OSA in young patients. Abnormal anatomy can worsen the symptoms of obesity related OSA. The commonly found anatomical abnormalities are deviation of the nasal septum, hypertrophy of inferior turbinate’s, adeno-tonsillar hypertrophy, retrognathia, weak epiglottis & mass lesions of upper aerodigestive tract (nasal polyposis, bulky tongue). The reduced muscle strength secondary to the fat deposition in & around the upper aerodigestive tract is unable to maintain the adequate airway lumen required for the healthy sleep. The moderate to excessive narrowing of airway lumen, easy collapsibility pharyngeal part of airway & induced negative pressure distal to the site of obstruction generates partial to complete blockage of the airway. The oxygen level in blood decreases in OSA due to reduced volume of available air for gas exchange at lung alveoli level. The arousal episodes occur during sleep due to induced signals from the brain when blood oxygen level reaches below threshold level. Poor sleep induces excessive daytime sleepiness, morning headache, dry mouth, inattentiveness & irritability are the common presenting symptoms. OSA has a great impact on quality of life at school, working place & at home. Day time sleepiness increases the chances of road traffic & household accidents. The induced negative pressure in the airway, episodic fall in blood oxygen level affects almost all of the body systems. OSA increases the risk of stroke, & heart attack by many folds. Polysomnography helps in differentiating OSA from other mimicking diseases.

The multidisciplinary approach is required to manage the OSA. The detailed airway assessment is required from the ENT doctor for anatomical features. The site of airway narrowing is determined by combination of clinical assessment with site localizing investigations. Apneograph, sleep MRI & DISE are investigations used by ENT surgeons to localize the site of obstruction. The site directed surgery increases the long term effectiveness of surgery. The majority of anatomical abnormalities are correctable by surgical intervention. Young age OSA can be completely reversed by surgical correction in abnormal anatomy patients. The severity of obesity related to OSA can be reduced by healthy lifestyle, regular exercise, balanced diet & correction of the sleeping position. PAP therapy is mostly followed treatment for obesity related OSA. The machine maintains the blood oxygen level during obstructive episodes but the long term compliance falls around 50%. The correction of abnormal anatomy can remove and/or increase the compliance of PAP therapy. Surgical success is persistent if an OSA patient follows a healthy lifestyle.

 

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Neurology News

Brain and spine tumour operations now safe, with advances in surgical and radiological techniques

by Pragati Singh
written by Pragati Singh

A nervous system tumour is an abnormal development of tissue in the brain or spine that can interfere with normal neural function.

Neuro and spine surgeons classify tumours depending on where the tumour cells started, whether they are cancerous (malignant) or not (benign), and whether they are primary (originating from brain cells) or metastatic (originating from other tissues) (begin in other parts of the body and spread to the brain).

A general symptom is caused by the pressure of the tumour on the brain or spinal cord. Specific symptoms are caused when a specific part of the brain is not working well because of the tumour.  The symptoms may be recurrent headaches, issues with vision, seizures, changes in personality, memory loss, poor coordination, difficulty speaking or comprehending.

Spine tumours can give rise to neck or back pain, weakness of any limbs or urinary or bowel trouble-depending upon the part of the spine involved.

Neurosurgeons use many tests to diagnose brain and spine tumours, find out the type of brain and spine tumour, and rarely, find out if it has spread to another part of the body, called metastasis.

The most common imaging tests used for diagnosing a brain and spine tumour include MRI, MR Spectroscopy, Perfusion MRI, Functional MRI, CT Scan, PET Scan, cerebral angiogram, MR Myelogram, X Rays.

The World Health Organization (WHO) has created a standard by which all tumours are classified. Tumours are given a name based on the cells where they arise, and a number ranging from 1 to 4. The number is called the grade and it represents how fast the cells can grow and are likely o spread. This is critical information for planning treatment and predicting outcomes.

For most types of tumours, taking a sample of tumour tissue, either by biopsy or by surgically removing part of the total tumour, is the only way to make a definitive diagnosis of a brain tumour.

Treatment options and recommendations depend on several factors: the size, type, and grade of the tumour, whether the tumour is putting pressure on vital parts of the brain if the tumour has spread to other parts of the CNS or body, the patient’s preferences, and overall health.

With the advances in surgical and radiological techniques: Microsurgery, Endoscopic Surgery, Image-guided surgery, intraoperative monitoring it has become very safe to remove brain and spine tumours without causing much morbidity and mortality.

The most common treatment options available for a brain tumour are –

  • Surgical remove- Microsurgery, Endoscopic surgery, Image-guided surgery, Biopsy, Decompression, and total microscopic excision
  • Radiation therapy
  • Chemotherapy
  • Targeted Therapy
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Neurology News

Hypertension linked to 2.5 times higher risk of epilepsy

by Vaishali Sharma
written by Vaishali Sharma

  • Researchers investigated the link between high blood pressure and epilepsy.
  • They found that high blood pressure increases the risk of epilepsy by around 2.5 times but taking antihypertensive medications reduces this risk.
  • They conclude that while high blood pressure is a risk factor for epilepsy, further research is needed to understand the underlying mechanisms of the link.After stroke and dementia, epilepsy is the third most frequent neurological illness that affects the elderly.Late-onset epilepsy has become increasingly common in the previous two decades, according to research. As the population ages, the number of persons suffering from epilepsy is projected to climb, and epilepsy will likely become a major public health issue.Despite this, the fundamental causes of epilepsy are unknown in 32–48% of casesTrusted Source. a little research According to Trusted Source, vascular risk factors may raise the likelihood of late-onset epilepsy. Other studies According to Trusted Source, vascular risk factors may be implicated.

     

    Understanding the role of vascular risk factors in late-onset epilepsy could help policymakers design public health measures and preventive strategies to curb and manage rates of the condition.Researchers from Boston University School of Medicine in the United States have undertook a study to look at the link between vascular risk factors and epilepsy development.

    They discovered that hypertension was linked to a nearly 2-fold increased incidence of late-onset epilepsy. This risk was much higher for people who did not use blood pressure medication to control it.

 

 

  Data analysis

The researchers used data from the Framingham Heart Study (FHS), an ongoing, community-based study that began in     1948. Its Offspring Cohort tracks the health outcomes of 5,124 of the original participants’ children from health                 examinations every 4 years.

Altogether, the researchers used data from 2,986 people who attended their fifth examination between 1991 and 1995, were at least 45 years old during the period, and whose health records contained data on vascular risk factors.

The vascular risk factors collected included systolic and diastolic blood pressure. The researchers characterized high blood pressure as systolic blood pressure of 140 millimeters of mercury (mm Hg) and above, and diastolic blood pressure of 90 mm Hg and above, as well as the use of antihypertensive medications.

The researchers also screened for:

  • diabetes
  • cholesterol levels
  • smoking status
  • cardiovascular disease
  • stroke
  • body mass index (BMI)

To screen participants for epilepsy or seizure, the researchers used routine chart reviews for neurological conditions, self-reported seizures, International Classification of Diseases Ninth Revision (ICD-9)Trusted Source codes linked to epilepsy or seizures, and antiepileptic drug use.

The researchers also used brain imaging and electroencephalography (EEG), cardiac and other relevant data to ascertain cases of epilepsy.

Among the cohort, the research identified 55 examples of epilepsy, of which 26 were definite, 15 probable, and 14 suspected. Individuals were an average of 73.8 years old at the time of potential diagnosis.

The researchers found that hypertension had links to an almost 2-fold higher risk of epilepsy. However, the other risk factors had no links to epilepsy.

After excluding people taking antihypertensive medications, the researchers noted that high blood pressure had links to a 2.44-fold high risk of developing epilepsy.

They also found that every 10 mm Hg change in systolic blood pressure was associated with a 17% higher risk of developing epilepsy.

 

 

Underlying mechanisms

Several theories may explain the link between epilepsy and hypertension. One mechanism may be via the renin-angiotensin system (RAS)Trusted Source, which regulates blood pressure.

ResearchTrusted Source suggests that after repetitive seizures, rats have 2.6–8.2 times the components of RAS than mice without seizures. Antihypertensive drugs that lowered levels of RAS components delayed seizure onset and reduced seizure frequency.

However, more research is needed to understand how much this mechanism explains the link between epilepsy and hypertension, as other research suggests the system may have a limited effect.

According to the researchers, another possible underlying mechanism is small vessel disease (SVD)Trusted Source, a condition in which the walls of small arteries and capillaries are damaged and thus do not deliver sufficient oxygen-rich blood to various organs. In a recent study, scientists foundTrusted Source that the duration of high blood pressure is a strong predictor of SVD in later life.

The researchers add that SVD has links to temporal lobe epilepsy. Possible mechanisms include cortical microinfarcts, small lesions in cortical tissue, and the disruption of U fibersTrusted Source that may lead to excessive excitability and thus seizures. U fibers connect neighboring areas of the cerebral cortex.

 

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Neurology News

Anti-Inflammatory Diet: What You Eat Could Maintain Cognitive Health, Lower Risk of Dementia

by Pragati Singh
written by Pragati Singh

As people become older, their immune systems become more inflammatory, which damages cells. People who ate an anti-inflammatory diet rich in fruits, vegetables, beans, and tea or coffee had a decreased chance of acquiring dementia later in life, according to a recent study. The study will be published in the online edition of Neurology®, the medical journal of the American Academy of Neurology, on November 10, 2021.

“There may be some potent nutritional tools in your home to help fight the inflammation that could contribute to brain aging,” said study author Nikolaos Scarmeas, MD, PhD, of National and Kapodistrian University of Athens in Greece, and a Fellow of the American Academy of Neurology. “Diet is a lifestyle factor you can modify, and it might play a role in combating inflammation, one of the biological pathways contributing to risk for dementia and cognitive impairment later in life.”

The study looked at 1,059 people in Greece with an average age of 73 who did not have dementia.

Each person answered a food frequency questionnaire that is commonly used to determine the inflammatory potential of a person’s diet. The questionnaire sought information on the main food groups consumed during the previous month, including dairy products, cereals, fruits, vegetables, meat, fish, legumes, which include beans, lentils and peas, added fats, alcoholic beverages, stimulants, and sweets. A possible dietary inflammatory score can range from -8.87 to 7.98, with higher scores indicating a more inflammatory diet, which includes fewer servings of fruits, vegetables, beans, and tea or coffee.

Scarmeas notes that multiple nutrients in all foods contribute to the inflammatory nature of a person’s diet.

Researchers divided the participants into three equal groups: those with the lowest dietary inflammatory scores, medium scores, and highest scores. Those in the group with the lowest scores of -1.76 and lower, indicating a more anti-inflammatory diet, ate an average per week of 20 servings of fruit, 19 of vegetables, four of beans or other legumes and 11 of coffee or tea per week. Those in the group with the highest scores, 0.21 and above, indicating a more inflammatory diet, ate an average per week of nine servings of fruit, 10 of vegetables, two of legumes and nine of coffee or tea.

Researchers followed up with each person for an average of three years. Over the course of the study, 62 people, or 6%, developed dementia. The people who developed dementia had average scores of -0.06, compared to average scores of -0.70 for those who did not develop dementia.

After adjusting for age, sex and education, researchers found that each one-point increase in dietary inflammatory score was associated with a 21% increase in dementia risk. Compared to the lowest third of participants who consumed the least inflammatory diet, those in the top third were three times more likely to develop dementia.

“Our results are getting us closer to characterizing and measuring the inflammatory potential of people’s diets,” Scarmeas said. “That, in turn, could help inform more tailored and precise dietary recommendations and other strategies to maintain cognitive health.”

The study was an observational one, not a clinical trial. It does not prove that eating an anti-inflammatory diet prevents brain aging and dementia, it only shows an association.

An additional limitation is the short follow-up time of three years. Longer studies are needed to confirm and replicate these findings.

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Stroke
ExclusivesInterviewsNeurology News

6 Signs that might help deter if one having a stroke: “BE FAST”!

by Vaishali Sharma
written by Vaishali Sharma

Strokes can happen to anyone anywhere and on the occasion of World Stroke Day, neuro experts from AIIMS explained the “BE FAST” rules to prevent sudden deaths caused by strokes.

To learn more, read the following excerpts from Medically Speaking’s conversation with the expert panel, which included: Dr SS Kale, HOD, Neurosurgery, AIIMS; Dr Padma, HOD, Neurosciences, AIIMS; Dr Sanjay Wadhwa, HOD PMR Department, AIIMS.

In simple layman’s term please help us understand why are we even talking about stroke, what exactly is a stroke and why is it important , so pertinent in a country like us and how do we increase awareness around stroke ?

Dr Padma: Stroke, as we call it, a brain attack, is so staggering in terms of the burden of illness in society, especially in the developing world, where India is a prototype. As I speak now, we have a stroke happening every 20 seconds, and a stroke debt every 2 minutes. In a year, I mean last year, we had 18 lakh stroke patients in India, out of which 25% were younger than 40 years old. A brain attack or a stroke is an acute paralysis or acute weakness on one side of the body, that is, when there is a shortage of blood supply to the brain. If there is a clot or if there is a breakage of the blood vessel and bleeding and there is a lack of blood supply to the brain, there is an attack. An attack justifies the emergent action which is required. It is all within minutes, and so that’s why the theme for this world stroke day is “Time Saves Lives” and every minute counts.

 

Why is awareness around stroke so important and how can these crucial golden minutes really help in saving someone’s life sir?

Dr SS Kale: The problem is with the blood supply of the brain. If it stops suddenly, the neurons start dying, and unfortunately, neurons are one of those few cells that do not re-generate. If you might have noticed that the skin re-generates itself, other tissues heal themselves, wounds get healed on their own, there might be a scar, but unfortunately, if the neurons in the brain die, they will never come back again. That is why it is crucial to save as many neurons as you can. So, that is why it is important to act within minutes or at the most within the hour.

 

What are the symptoms of stroke and how should someone perhaps who is around someone should know that a person is getting a stroke and what do they do to save that person?

Dr Sanjay Wadhwa: One of the easiest ways to remember what the warning signs or deterrent signs of stroke are is by using the word “FAST,” because a stroke is an emergency and indicates that one must act fast. So, in the word FAST, F stands for FACE, A stands for ARM, S stands for Speech, and T stands for Time. Because time is of great essence, when the face gets affected by a stroke, the arm may become weak, the speech may get slurred or lost, and it all happens very suddenly in general. Some people have also added BE FAST to these alphabets. Here, B stands for balance and E for eyes, because some people have imbalances or loss of balance, and some people may have a diminution of vision. So, the symptoms and indications of stroke can be summed up very simply: BE FAST. This also encourages and emphasises that if there is a suspicion of stroke, act immediately because if there is a delay, thousands or millions of brain cells may die permanently.

 

What should one do when they see someone having a stroke? Slurring in speech, numbness in the arm is certain, prominent telltale signs of a stroke. How can a person expedite the reaction time?

Dr Padma: It could be a sudden loss of consciousness to which every body reacts, or it could be a very subtle deviation of the mouth or some weakness on one side, or people say it’s possible that glucose is less in the body, and sometimes a stroke even presents it that way. There are several ways to react to it: one, if you are aware that there is any sudden change in the function of the body, that’s the hallmark of it, because the brain is a super computer that commands every single action. At that moment, I rushed to the nearest stroke-ready hospital. We need to have a map of these stroke ready hospitals. All the doctors and medical people are now aware that the moment there is a stroke, they immediately need to treat the patient and shift him or her to a stroke-ready hospital where a diagnosis can be made, because for a diagnosis, you need at least a CT-SCAN machine. Secondly, try to determine if there is a clot in the artery. You need to unclog it, either by intravenous technique or sometimes by mechanically taking it out with a bigger center. There are primary stroke-ready centres and even more advanced stroke centers. We do have those, but the thing is that you need to recognise and rush to a stroke-ready hospital. That’s how you manage a stroke.

 

What types of stroke and what really causes a stroke , hypotension is the one reason we know  , tell us other reasons that could cause a stroke ?

Dr SS Kale: One is when the blood supply is suddenly cut off, or if not entirely to the brain, but one part of the brain, say the part of the brain which controls your right side, will suddenly stop working. They will die, and then the right side of the person’s body will stop working. I say the right hand, leg, or right side of the face, and sometimes all three together. So, that is one kind of stroke. The second type of stroke is the hemorrhagic stroke. When there is a lot of sudden bleeding in the brain, or one of the vessels bursts, it could be an artery or sometimes a vein, which causes a clot of blood to sit in some area of the brain, and this clot of blood causes pressure on the neurons, which again causes damage wherever it is sitting. So basically, there are these two types of strokes, and in the second one, the blood should remain in the blood vessels, but if it escapes, it can cause a hemorrhagic stroke. Now let’s come to the risk factors. Which people can get a stroke? Am I likely to get a stroke? If I am an elderly person, then the chances of a stroke are higher. If I am hypertensive, my chances would be higher. If I am a diabetic, my chances would be higher. If I have hyperlipidemia, I am likely to have a stroke. So these are the kinds of risk factors that we talk about. We generally divide these risk factors into two types. One is modifiable, where we can bring a change by intervention. For example, if I am obese, I can do exercise, I can change my diet, I can lose weight, I can become fit, etc. But there are certain factors which are non-modifiable, such as age. If I am already 75, I cannot change my age.

 

Can lifestyle changes reduce the chances of stroke or can they actually prevent stroke all together sir?

Dr Sanjay Wadhwa: Lifestyle has a major role to play in the causation of non-communicable diseases and stroke is one of the leading examples. People who have very bad habits of eating they are likely to put on weight so by way of obesity they’re likely to have diabetes which is a risk factor for stroke. If you intervein in modifying the lifestyle then you can reduce the risks of stroke to a significant extent and some other diseases that I mentioned just now.

 

Can those people also who perhaps are at a disadvantage because of these uncontrollable factors, can they also make it some modification ,at least reduce the stroke?

Dr Padma: A lot of these what we call conventional risk factors, such as hypertension, also, of course, diabetes and your propensity to put on weight. It is obviously not always in your hands that you are eating a lot; sometimes you have this genetically and it just becomes a pear-shaped body. Even if you’re genetically predisposed, you don’t have to have this. You can prevent your heart attack and brain attack, so being aware of this and not being complacent about it matters.

 

85% people have unfortunately experienced in stroke but many of them lead a normal life even after that. Please elaborate a little bit on the rehabilitation part.

Dr SS Kale: There are ways and means available which can help mitigate the loss which you’ve suffered because of a stroke. First thing is to follow doctor’s advice and make all the necessary changes in your diet or schedule so that risk factors again come into play. People are now trying to device implants which can allow a person to see again. We have seen people with completely paralysed patients where the exoskeletons start working.

 

We are speaking of the three R’s of stroke, how to spot a stroke fast also three R’s of stroke recognition, rehabilitation and recovery. Elaborate a little bit on the rehabilitation and recovery part.

Dr Sanjay Wadhwa: There are ways and means available which can help mitigate the loss which you’ve suffered because of a stroke. You can modify risk factors and try to prevent it as much as possible, but some unfortunate people do suffer from it. It is important to remember that, unfortunately, some of the people who suffer strokes die. But a large majority of people survive and many of these survive with a residual disability. Rehabilitation is a journey that normally begins in an institutional setting.

Stroke rehabilitation can begin as early as 24-48 hours after onset of acute stroke, so we have to initiate early steps so that extent of disability is reduced as much as possible. Education, equipment and modification of the immediate environment are some of the components of a comprehensive rehabilitation plan. Professor Padma Srivastav was a key contributor to the development of all of these guidelines, which are very comprehensive and have been endorsed by the ministry of health and family welfare.

 

Unfortunately we are seeing a large number of population being affected by strokes which is a younger population something perhaps which is not very common at least a decade ago it increased by 100% correct. What would be your message?

Dr Padma: Number one prevents strokes. You just have to One super computer, which is equal to your life, prevents anything from happening to it. Traffic accidents are also brain attacks. Number two-if there is a stroke happening, be aware of how to recognise it and reach out as an emergency. It is an emergency, so you should not waste any time, as again, we say, time saves lives. Every minute counts. That’s the team of the World Strike Day. Number three: if there is an unfortunate incident, don’t lose hope. The earlier you rehabilitate, the better the recovery. Never lose hope. Every stroke recovers to a small or large extent. It’s in your hands.

 

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Neurology News

Stroke likely to become more severe in Covid-infected people: AIIMS doctors

by Vaishali Sharma
written by Vaishali Sharma

Stroke among persons infected with the coronavirus is likely to be more severe, and their odds of recovery are about half that of stroke patients who are not infected with Covid-19, according to experts at AIIMS on Friday.

Patients who have a stroke linked to Covid-19 also have a higher mortality and morbidity rate, according to Dr Rohit Bhatia, Professor, Department of Neurology at AIIMS.

The 29th of October is World Stroke Day.

The world’s most prestigious medical institution has done multi-centric investigations on stroke outcomes before and throughout the epidemic, as well as the clinical profile and result of stroke in patients who do not use Covid-19.

“Generally a good recovery is called when a patient of stroke becomes independent in daily activities within three months of the stroke. Covid-19-related strokes are likely to be more severe and also associated with relatively poorer outcomes. However, it is still not clear whether Covid is causative or associated with the occurrence of stroke,” he said.

AIIMS collaborated with 17 other hospitals across the country to study the changes in stroke treatment pathway in 2,500 patients before and during the pandemic. The study outcomes suggested that there were some treatment delays and mild increase in mortality in the patients during the pandemic period.

Endovascular Thrombectomy, an important procedure among patients with Ischemic stroke due to large vessel occlusion, reduced significantly during the pandemic. Several other procedures were also delayed, Bhatia said.

“Covid-19 is known to manifest and involve several other organs in the illness. The brain is among them. There is no definitive evidence to say that Covid can directly cause stroke, though it may add to the risk of clot formation,” said Dr M V Padma Srivastava, chief of Neurosciences Centre at AIIMS.

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Neurology NewsNutrition News

World Stroke Day: Foods to avoid for prevention of stroke

by Pragati Singh
written by Pragati Singh

World Stroke Day: A stroke occurs when blood supply to a part of the brain is interrupted or reduced, causing brain tissues to be damaged. There are numerous lifestyle factors that can increase your risk of stroke, ranging from poor eating habits and obesity to a lack of exercise and a sedentary lifestyle.

It is possible to reduce the risk of a stroke by managing certain health conditions like blood pressure, cardiac diseases, diabetes, cholesterol, obesity, refraining from tobacco, staying away from alcohol and reducing stress. Regular exercise and balanced diet could also help.

“Stroke is the leading cause of morbidity and mortality in the world. Various lifestyle habits can increase the risk of stroke. Food habits are not far behind so let’s look at food stuff that we may eat routinely that increases our risk of stroke,” says Dr Praveen Gupta, Principal Director & Head, Department of Neurology, Fortis Memorial Research Institute, Gurugram.

1.Processedfoods

If you begin and end your day with junk food and look for excuses to indulge in trans-fat laden food, you should be very careful as you are increasing your risk of getting a stroke. “Processed foods or junk foods, such as crackers, chips, store-bought goods and fried foods, typically contain a lot of trans fat, which generates bad cholesterol called LDL which deposits in the wall of arteries leading to blockage. It also leads to inflammation in the body. It is this increase in the inflammation of the body that is a foundation of many diseases like stroke and heart attacks,” says Dr Gupta.

2.. Smoked and processed meats

There are certain preservatives in smoked and processed meats like sodium nitrite that can damage the blood vessels and thus increase stroke risk. They cause oxidative stress leading to vessel wall damage and tissue injury. Examples of smoked and processed meats include hot dogs, bacon and salami. Ideally, you should limit smoked and processed meats completely from your diet. 

3. Table salt

Salt here refers to processed salt found in packaged foods and table salt. Natural, unrefined salt, such as Himalayan salt, is not associated with increased stroke risk and can be used to flavour food. Salt elevates blood pressure giving rise to injuries of arteries, brain and the heart. In fact, reducing salt by 5 gm a day can significantly lower blood pressure and hence stroke risk.

4. Diet soft drinks

“Diet drinks are misleadingly attractive. Many people think because a soda is labeled “diet” it’s a better choice, but studies have linked diet soft drink consumption with an increased risk of stroke and vascular disease. In a nine-year study of more than 2,500 people, those who drank diet soda daily were 48 per cent more likely to have a heart attack or stroke or die from those events, compared with those who rarely or never drank soda,” says Dr Gupta. Thus avoiding certain foods can decrease stroke risk and set stage for a long healthy life.

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Neurology News

Meningitis: Researchers find possible treatment strategy without antibiotics

by Vaishali Sharma
written by Vaishali Sharma

Fever, headache, confusion, seizures, amputations or death. Meningitis is a very serious brain infection that can affect the body in many ways and needs to be treated within 24 hours of contracting the disease. The World Health Organization estimates that there are close to three million cases per year. Between the four main causes of meningitis, the WHO is particularly concerned about bacterial meningitis, which is caused by the infectious bacteria Streptococcus pneumoniae.

Despite widespread implementation of vaccines, bacterial meningitis is still associated with a high mortality rate and neurological consequences including hearing loss, focal neurological deficits and cognitive impairment, estimated to occur in close to half of surviving patients.

Antibiotic treatment is necessary, but with the increasing threat of antibiotic resistance, there is a growing need for new treatment strategies.

Now, in a new study performed in rats, researchers from the University of Copenhagen and Lund University were able to utilize the body’s own immune cells to kill the bacterial meningitis infection.

“In a rat model we observed that the neutrophils, a type of immune cells, form a net-like structure in the brain’s membrane, the meninges. But this particular net-structure also causes brain swelling and prevents removal of waste products. We discovered, that if we dissolved the structure — not the immune cells — the immune cells still kill the meningitis bacteria but without causing brain swelling,” says Ph.D. Chiara Pavan, first author on the study.

Immune cells block movement of brain fluid

The researchers show that immune cells entering the brain’s membrane, create a net that traps bacteria but also blocks the movement of cerebrospinal fluid. The brain is constantly cleaned by the cerebrospinal fluid that enters the tissue along blood vessels and is responsible for clearing out waste products made by the active brain cells.

This fluid transport system was named the glymphatic system by Maiken Nedergaard, and its function has been shown to be critical for avoiding accumulation of protein plaques that accumulates in patients with Alzheimer disease. Glymphatic transport of cerebrospinal fluid is also important for avoiding brain swelling in acute diseases such as stroke.

Brain swelling, also called edema, is a life threatening condition because the brain is contained within the skull. The swelling compress blood vessels resulting in loss of the brain tissue, which is fatal when the brain regions that controls breathing stops working.

That brain swelling in meningitis is caused by blockage of the glymphatic system is now shown for the first time in collaboration between Maiken Nedergaards group at the University of Copenhagen and Iben Lundgaard at Lund University.

“When the immune cells enter the brain, they eat the bacteria, but while doing so the immune cells also produce inflammatory components, including nets that cause swelling,” says Maiken Nedergaard, the lead author from the University of Copenhagen.

“The most important aspects of our study is that it suggests that meningitis can be treated by administration of an enzyme that degrades the neutrophil nets. Enzymatic removal of nets eliminated the often fatal accumulation of fluid in the brain in rats with bacterial meningitis. This novel treatment can be combined with antibiotics if needed,” she says.

Hope for an international clinical study

The researchers theorized that if the nets were dissolved, leaving just the immune cells without their nets in the meninges, it would allow the cerebrospinal fluid to pass the brain freely.

The net-like structures consist mainly of DNA, so the research team applied drugs for cutting up DNA, so-called DNase. They gave DNase to the rats infected with pneumococcus bacteria, which causes bacterial meningitis.

“We administered DNase to rats infected with the bacteria, and we were able to show that the nets dissolved. The treatment reduced brain swelling and helped in removing metabolic waste production from the infected brain. In contrast, antibiotic treatment did not have an effect on brain swelling or waste clearance,” says Maiken Nedergaard.

Based on their results, the research team now hopes to set up an international clinical study to investigate DNase in the treatment of patients with bacterial meningitis. Antibiotic resistant is increasing at an alarming rate and the drug the researchers use here is a promising alternative, and has already been approved for human use in other neurological diseases.

“We would also like to investigate how metabolic waste products removal is impaired in other disease of the brain such as multiple sclerosis or viral meningitis,” says Maiken Nedergaard.

Source: University of Copenhagen – The Faculty of Health and Medical Sciences

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